HomeMy WebLinkAboutPlumbing Permit #13-091 y ❑ O� n ❑0000❑ _ � o y�
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,� CITY OF PRIOR LAKE PLUMBING PERMIT
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�. 8�,� File PERMIT NO. �� �' �
2. Gold Ciry
3. Yellow Applicant
ease or t and si at bottom
ADDRESS ZONING (o�ce ��
I � T�r c� �('��+�G�i � 1� �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION pID
(Na�in E �\-1 Y\Gl.� �— r�� W�/�. (Phone) 1 l� 1 1� �`` �
(Address) �'(" �r` ► . ���j 6 �--
� PLICANT � � � (phone) � J'�J�' 1�� �
ame
(Address) � � � �� (i1 1�- - �— � � ��
Address) ( ity) (Zip Code)
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(Contact Person) � hone) ���ld'J' 1���
APPLICANT SIGNATURE DATE �� �'1 �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fizture u�nti T e of Fixture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato athroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEE SCHEDULE
Industrial, Commercial8c Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $ �' �
until june 30 201.3 STATE SURCHARGE $ •. D 6'
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is �5.�0
--- --rr---^���° y��°•°�° _��= y�•=ding Permit When Approved Paid �-� �--�, Receipt No. ` D �/
�7 �7
Date �/3 BY
Bnildins Official Date
24 6our notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior L�ke, Minnesota 55372 �
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